老年患者急性冠状动脉综合征的院内死亡率。

In-hospital mortality of acute coronary syndrome in elderly patients.

作者信息

Ahmed Omima E, Abohamr Samah I, Alharbi Shaima A, Aldrewesh Dawood A, Allihimy Abdulaziz S, Alkuraydis Sarah A, Alhammad Ibtihal M, Elsheikh Eman, Azazy Ahmad S, Mohammed Asim A, Dar Mehboob A, Abazid Rami M

机构信息

Department of Cardiology, Prince Sultan Cardiac Center Qassim, Qassim, Buraydah, Kingdom of Saudi Arabia.

出版信息

Saudi Med J. 2019 Oct;40(10):1003-1007. doi: 10.15537/smj.2019.10.24583.

DOI:10.15537/smj.2019.10.24583

PMID:31588478

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6887884/

Abstract

To analyze predictors of death in elderly patients diagnosed with acute coronary syndrome (ACS). Methods: A record-based study carried out between January 2016 and January 2018 at The central province in Saudi Arabia. All elderly patients (greater than 75 years) with definite diagnosis of ACS were retrospectively included. Demographic data, echocardiographic, and angiographic parameters were reported. Results: A total of 179 patients were enrolled, 129 (72%) were male. The mean age was 79±4.7 years. Approximately 102 (57%) patients were diagnosed with ST-segment elevation myocardial infarction (STEMI). Of all 125 (70%) underwent invasive coronary angiography, we found that 43 (24%) had significant single vessel disease (1VD), 29 (16.2%) had 2 vessel disease (2VD), and 41 (22.9%) had 3 vessel disease (3VD) or left main stenosis. During hospitalization 21 (11.7%) patients died, t-test analysis showed patients who died were significantly older (82±6.7 versus [vs.] 79±4.2 years, p=0.003). In addition we found that ejection fraction was lower in death group (30.2%±10.7) vs. (36.5%±1.1) in survivors, p=0.017); STEMI was more common in death group (90.5%) vs. (52.5%) in survivors, p=0.001); similarly, the prevalence of 3VD was higher in death group (38.1%) vs. (20.9%) in survivors, p=0.018). Importantly, PCI was not significantly different between death and survival groups (40% vs. 53.8%, p=0.177). A multivariate regression analysis demonstrated that predictors of death were: age (hazard ratio [HR], 1.214; 95% confidence interval [CI], 1.122-1.384; p less than 0.0001), intubation (HR, 10.106; 95% CI, 9.844-10.792; p less than 0.0001), and raised creatinine kinase-MB (CK-MB) (HR, 1.005; 95% CI, 1.002-1.013; p=0.04) predicted in hospital death. Conclusion: Older age, mechanical ventilation and raised CK-MB can significantly predict death in elderly patients (greater than 75-year-old) diagnosed with ACS; nevertheless, PCI showed no survival benefits.

摘要

分析老年急性冠状动脉综合征（ACS）患者的死亡预测因素。方法：2016年1月至2018年1月在沙特阿拉伯中部省份进行的一项基于记录的研究。回顾性纳入所有确诊为ACS的老年患者（年龄大于75岁）。报告了人口统计学数据、超声心动图和血管造影参数。结果：共纳入179例患者，129例（72%）为男性。平均年龄为79±4.7岁。约102例（57%）患者被诊断为ST段抬高型心肌梗死（STEMI）。在所有125例（70%）接受有创冠状动脉造影的患者中，我们发现43例（24%）有显著单支血管病变（1VD），29例（16.2%）有双支血管病变（2VD），41例（22.9%）有三支血管病变（3VD）或左主干狭窄。住院期间21例（11.7%）患者死亡，t检验分析显示死亡患者年龄显著更大（82±6.7岁对[vs.]79±4.2岁，p=0.003）。此外，我们发现死亡组的射血分数低于存活组（30.2%±10.7对[vs.]36.5%±1.1），p=0.017）；STEMI在死亡组中更常见（90.5%）对[vs.]存活组中的（52.5%），p=0.001）；同样，3VD在死亡组中的患病率更高（38.1%）对[vs.]存活组中的（20.9%），p=0.018）。重要的是，死亡组和存活组之间的PCI无显著差异（40%对53.8%，p=0.177）。多因素回归分析表明，死亡的预测因素为：年龄（风险比[HR]，1.214；95%置信区间[CI]，1.122 - 1.384；p小于0.0001）、插管（HR，10.106；95%CI，9.844 - 10.792；p小于0.0001）以及肌酸激酶-MB（CK-MB）升高（HR，1.005；95%CI，1.002 - 1.013；p=0.04）预测住院死亡。结论：高龄、机械通气和CK-MB升高可显著预测老年（大于75岁）ACS患者的死亡；然而，PCI未显示出生存益处。